A collateral history evidences that he is ordinarily active, continues to work and had been well until 2 days ago, when he started to feel non-specifically unwell.
His regular medications are: aspirin, bisoprolol, clopidogrel, dapagliflozin, metformin, rosuvastatin and sacubitril with valsartan.
An arterial blood gas is taken, showing: pH <6.80, PaO2 11.1 kPa, PaCO2 2.3 kPa, Na+ 134 mmol/L, K+ 4.1 mmol/L, Cl- 90 mmol/L, glucose 8.3 mmol/L, lactate 15.4 mmol/L, BE ‘incalculable’, HCO3- ‘incalculable’
Capillary ketones read >6 mmol/L.
An ECG shows sinus tachycardia.
A bedside point of care echocardiogram shows severe generalised biventricular systolic dysfunction.
